Technology & Policy

Social Media in Disaster Preparation, Response, and Recovery

Social Media in Disaster Preparation, Response, and Recovery
TR News July-August 2013: Logistics of Disaster Response

Sarah M. Kaufman
09/27/2013

Social media have become an essential source of information before, during, and after disasters. Social networks like Twitter, Facebook, and Tumblr—instantaneous, far-reaching, and interactive— have become the convergence point for a range of information sources, dialogues, and dynamic content. A survey conducted by the New York University (NYU) Rudin Center for Transportation Policy and Management found that during Superstorm Sandy, social media were the second-highest-rated source of information, ranking higher than other popular sources such as television and radio news, news websites, and community groups.

Monitoring the pulse of hospital activity: Electronic health record utilization as a measure of care intensity

Monitoring the pulse of hospital activity: Electronic health record utilization as a measure of care intensity
Journal of Hospital Medicine, Vol. 8, no. 9, pp. 513-518. DOI: 10.1002/jhm.2068

Blecker, S., J.S. Austrian, D. Shine, R. Scott Braithwaite, M.J. Radford, and M.N. Gourevitch
09/01/2013

Background: Hospital care on weekends has been associated with reduced quality and poor clinical outcomes, suggesting that decreases in overall intensity of care may have important clinical effects. We describe a new measure of hospital intensity of care based on utilization of the electronic health record (EHR).

Methods: We measured global intensity of care at our academic medical center by monitoring the use of the EHR in 2011. Our primary measure, termed EHR interactions, was the number of accessions of a patient's electronic record by a clinician, adjusted for hospital census, per unit of time. Our secondary measure was percent of total available central processing unit (CPU) power used to access EHR servers at a given time.

Results: EHR interactions were lower on weekend days as compared to weekdays at every hour (P < 0.0001), and the daytime peak in intensity noted each weekday was blunted on weekends. The relative rate and 95% confidence interval (CI) of census-adjusted record accessions per patient on weekdays compared with weekends were: 1.76 (95% CI: 1.74-1.77), 1.52 (95% CI: 1.50-1.55), and 1.14 (95% CI: 1.12-1.17) for day, morning/evening, and night hours, respectively. Percent CPU usage correlated closely with EHR interactions (r = 0.90).

Conclusions: EHR usage is a valid and easily reproducible measure of intensity of care in the hospital. Using this measure we identified large, hour-specific differences between weekend and weekday intensity. EHR interactions may serve as a useful measure for tracking and improving temporal variations in care that are common, and potentially deleterious, in hospital systems.

Reimagining Governance in Practice: Benchmarking British Columbia’s Citizen Engagement Efforts

Reimagining Governance in Practice: Benchmarking British Columbia’s Citizen Engagement Efforts
The GovLab, May 2013

Andrew Young, Christina Rogawski, Sabeel Rahman, and Stefaan Verhulst
05/01/2013

Over the last few years, the Government of British Columbia (BC), Canada has initiated a variety of practices and policies aimed at providing more legitimate and effective governance. Leveraging advances in technology, the BC Government has focused on changing how it engages with its citizens with the goal of optimizing the way it seeks input and develops and implements policy. The efforts are part of a broader trend among a wide variety of democratic governments to re-imagine public service and governance.

At the beginning of 2013, BC’s Ministry of Citizens’ Services and Open Government, now the Ministry of Technology, Innovation and Citizens’ Services, partnered with the GovLab to produce “Reimagining Governance in Practice: Benchmarking British Columbia’s Citizen Engagement Efforts.”  The GovLab’s May 2013 report, made public today, makes clear that BC’s current practices to create a more open government, leverage citizen engagement to inform policy decisions, create new innovations, and provide improved public monitoring­—though in many cases relatively new—are consistently among the strongest examples at either the provincial or national level.

According to Stefaan Verhulst, Chief of Research at the GovLab : “Our benchmarking study found that British Columbia’s various initiatives and experiments to create a more open and participatory governance culture has made it a leader in how to re-imagine governance. Leadership, along with the elimination of imperatives that may limit further experimentation, will be critical moving forward. And perhaps even more important, as with all initiatives to re-imaging governance worldwide, much more evaluation of what works, and why, will be needed to keep strengthening the value proposition behind the new practices and polices and provide proof-of-concept.”

Surgical Decompression is Associated with Decreased Mortality in Patients with Sepsis and Ureteral Calculi

Surgical Decompression is Associated with Decreased Mortality in Patients with Sepsis and Ureteral Calculi
Journal of Urology, Vol. 189, no. 3, pp. 946-951. DOI: 10.1016/j.juro.2012.09.088

Borofsky, M.S., D. Walter,O. Shah, D.S. Goldfarb, A.C. Mues, and D.V. Makarov
03/01/2013

Purpose: The combination of sepsis and ureteral calculus is a urological emergency. Traditional teaching advocates urgent decompression with nephrostomy tube or ureteral stent placement, although published outcomes validating this treatment are lacking. National practice patterns for such scenarios are currently undefined. Using a retrospective study design, we defined the surgical decompression rate in patients admitted to the hospital with severe infection and ureteral calculi. We determined whether a mortality benefit is associated with this intervention.

Materials and Methods: Patient demographics and hospital characteristics were extracted from the 2007 to 2009 Nationwide Inpatient Sample. We identified 1,712 patients with ureteral calculi and sepsis. Multivariate logistic regression was performed to determine the association between mortality and surgical decompression.

Results: Of the patients 78% underwent surgical decompression. Mortality was higher in those not treated with surgical decompression (19.2% vs 8.82%, p <0.001). Lack of surgical decompression was independently associated with an increased OR of mortality even when adjusting for patient demographics, comorbidities and geographic region of treatment (OR 2.6, 95% CI 1.9–3.7).

Conclusions: Absent surgical decompression is associated with higher odds of mortality in patients with sepsis and ureteral calculi. Further research to determine predictors of surgical decompression is necessary to ensure that all patients have access to this life saving therapy.

Centralization of Radical Prostatectomy in the United States

Centralization of Radical Prostatectomy in the United States
Journal of Urology, Vol. 189, no. 2, pp. 500-506. DOI: 10.1016/j.juro.2012.10.012

Anderson, C.B., D.F. Penson, S. Ni, D.V. Makarov, and D.A. Barocas
02/01/2013

Purpose: Radical prostatectomy is a common treatment for organ confined prostate cancer and its use is increasing. We examined how the increased volume is being distributed and what hospital characteristics are associated with increasing volume.

Materials and Methods: We identified all men age 40 to less than 80 years who underwent radical prostatectomy for prostate cancer from 2000 to 2008 in the NIS (Nationwide Inpatient Sample) (586,429). Ownership of a surgical robot was determined using the 2007 AHA (American Hospital Association) Annual Survey. The association between hospital radical prostatectomy volume and hospital characteristics, including ownership of a robot, was explored using multivariate linear regression.

Results: From 2000 to 2008 there was a 74% increase in the number of radical prostatectomies performed (p = 0.05) along with a 19% decrease in the number of hospitals performing radical prostatectomy (p <0.001), resulting in an increase in annual hospital radical prostatectomy volume (p = 0.009). Several hospital variables were associated with greater radical prostatectomy volume including teaching status, urban location, large bed size and ownership of a robot in 2007. On multivariate analysis the year, teaching status, large bed size, urban location and presence of a robot were associated with higher hospital radical prostatectomy volume.

Conclusions: Use of radical prostatectomy increased significantly between 2000 and 2008, most notably after 2005. The increase in radical prostatectomy resulted in centralization to select hospitals, particularly those in the top radical prostatectomy volume quartile and those investing in robotic technology. Our findings support the hypothesis that hospitals with the greatest volume increases are specialty centers already performing a high volume of radical prostatectomy procedures.

How Social Media Moves New York, Part 2: Recommended Social Media Policy for Transportation Providers

How Social Media Moves New York, Part 2: Recommended Social Media Policy for Transportation Providers
NYU Rudin Center for Transportation, December 2012

Kaufman, Sarah.
12/01/2012

Social media networks allow transportation providers to reach large numbers of people simultaneously and without a fee, essential factors for the millions of commuters and leisure travelers moving through the New York region every day. This report, based on earlier findings (from Part 1), which analyzed local transportation providers’ use of social media, and a seminar on the subject in the wake of Hurricane Sandy, recommends social media policies for transportation providers seeking to inform, engage and motivate their customers.

The goals of social media in transportation are to inform (alert riders of a situation), motivate (to opt for an alternate route), and engage (amplify the message to their friends and neighbors). To accomplish these goals, transportation providers should be:

- Accessible: Easily discovered through multiple channels and targeted information campaigns

- Informative: Disseminating service information at rush hour and with longer-form discussions on blogs as needed

- Engaging: Responding directly to customers, marketing new services, and building community

- Responsive: Soliciting and internalizing feedback and self-evaluating in a continuous cycle

How Social Media Moves New York: Twitter Use by Transportation Providers in the New York Region

How Social Media Moves New York: Twitter Use by Transportation Providers in the New York Region
October 2012

Kaufman, Sarah M.
10/23/2012

Social media networks are valuable tools for the public outreach needs of transportation providers: they are free, instantaneous, reach large numbers of people simultaneously, and allow for sideline discussions. When transportation providers are trying to notify large numbers of passengers about delays, drivers about construction work, or bus riders about re-routes, they can “blast” messages through social media channels to reach their intended audience immediately (the audience accesses these networks far more frequently than the websites of their local transportation agencies). The goals of social media in transportation are to inform (alert riders of a situation), motivate (to opt for an alternate route), and engage (amplify the message to their friends and neighbors). Ideally, these actions would occur within minutes of an incident.

This report analyzes the use of social media tools by the New York region’s major transportation providers. It is focused on the effectiveness of their Twitter feeds, which were chosen for their immediacy and simplicity in messaging, and provided a common denominator for comparison between the various transportation providers considered, both public and private. Based on this analysis, recommendations are outlined for improving social media outreach. A subsequent report will propose policies and recommendations for enhanced information and engagement with users.

Augmented Reality and Urban Exploration

Augmented Reality and Urban Exploration
July 2012

Kaufman, Sarah M.
07/01/2012

Augmented Reality is beginning to shift the landscape of urban exploration, making the experience ever-more informative, from language translation applications to cultural enrichment tools. It will lead people to be more informed, advertised to, and assisted on every urban excursion, removing the traditional happenstance from urban exploration. It is unclear whether Augmented Reality (AR) will truly enhance experiences, lead to over-saturation of information and advertising, or a combination of the two. This paper will discuss the current and near-future uses of AR for city dwellers and the projected implications of ubiquitous information.

Patterns of Care and Outcomes Associated With Intensity-Modulated Radiation Therapy Versus Conventional Radiation Therapy for Older Patients With Head-and-Neck Cancer

Patterns of Care and Outcomes Associated With Intensity-Modulated Radiation Therapy Versus Conventional Radiation Therapy for Older Patients With Head-and-Neck Cancer
International Journal of Radiation Oncology Biology Physics, Vol. 83, no. 1, e101-e107. DOI: 10.1016/j.ijrobp.2011.11.067

Yu, J.B. P.R. Soulos,R. Sharma, D.V. Makarov, R.H. Decker, B.D. Smith, R.A. Desai, L.D. Cramer, and C.P. Gross
05/01/2012

Purpose: Intensity-modulated radiation therapy (IMRT) requires a high degree of expertise compared with standard radiation therapy (RT). We performed a retrospective cohort study of Medicare patients treated with IMRT compared with standard RT to assess outcomes in national practice.

Methods and Materials: Using the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER)–Medicare linked database, we identified patients treated with radiation for cancer of the head and neck from 2002 to 2005. We used multivariate Cox models to determine whether the receipt of IMRT was associated with differences in survival.

Results: We identified 1613 patients, 33.7% of whom received IMRT. IMRT was not associated with differences in survival: the 3-year overall survival was 50.5% for IMRT vs. 49.6% for standard RT (p = 0.47). The 3-year cancer-specific survival was 60.0% for IMRT vs. 58.8% (p = 0.45).

Conclusion: Despite its complexity and resource intensive nature, IMRT use seems to be as safe as standard RT in national community practice, because the use of IMRT did not have an adverse impact on survival.

The Population Level Prevalence and Correlates of Appropriate and Inappropriate Imaging to Stage Incident Prostate Cancer in the Medicare Population

The Population Level Prevalence and Correlates of Appropriate and Inappropriate Imaging to Stage Incident Prostate Cancer in the Medicare Population
Journal of Urology, Vol. 187, no. 1, pp. 97-102. DOI: 10.1016/j.juro.2011.09.042

Makarov, D.V., R.A. Desai, J.B. Yu, R. Sharma, N. Abraham, P.C. Albertsen, D.F. Penson, and C.P. Gross
01/01/2012

Purpose: According to guidelines most men with incident prostate cancer do not require staging imaging. We determined the population level prevalence and correlates of appropriate and inappropriate imaging in this cohort.

Materials and Methods: We performed a cross-sectional study of men 66 to 85 years old who were diagnosed with prostate cancer in 2004 and 2005 from the SEER (Surveillance, Epidemiology and End Results)-Medicare database. Low risk (no prostate specific antigen greater than 10 ng/ml, Gleason score greater than 7 or clinical stage greater than T2) and high risk (1 or more of those features) groups were formed. Inappropriate imaging was defined as any imaging for men at low risk and appropriate imaging was defined as bone scan for men at high risk as well as pelvic imaging as appropriate. Logistic regression modeled imaging in each group.

Results: Of 18,491 men at low risk 45% received inappropriate imaging while only 66% of 10,562 at high risk received appropriate imaging. For patients at low risk inappropriate imaging was associated with increasing clinical stage (T2 vs T1 OR 1.35, 95% CI 1.27–1.44), higher Gleason score (7 vs less than 7 OR 1.80, 95% CI 1.69–1.92), increasing age and comorbidity as well as decreasing education. Appropriate imaging for men at high risk was associated with lower stage (T4, T3 and T2 vs T1 OR 0.63, 95% CI 0.48–0.82, OR 0.67, 95% CI 0.60–0.80 and OR 0.87, 95% CI 0.80–0.86) and with higher Gleason score (greater than 8 and 7 vs less than 7 OR 2.18, 95% CI 1.92–2.48 and 1.51, 95% CI 1.35–1.70, respectively) as well as with younger age, white race, higher income, lower stage and more comorbidity.

Conclusions: We found poor adherence to imaging guidelines for men with incident prostate cancer. Understanding the patterns by which clinicians use imaging for prostate cancer should guide educational efforts as well as research to suggest evidence-based guideline improvements.

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